Determinants of remission in acute lymphoblastic leukaemia in a tertiary health facility in Southwestern Nigeria

Abstract

ABSTRACT

Background: The clinical outcome of Acute Lymphoblastic leukaemia (ALL) is still poor in Nigeria despite advances in treatment options available.  This study therefore seeks to identify the predictors of remission in patients with ALL in Ibadan, Southwestern Nigeria.

Methods: This was a retrospective study of all patients diagnosed of ALL between January 2021 and December 2022 at the University College Hospital, Ibadan. Data on socio-demographic: age, gender and clinical features, full blood count, chemotherapy regimen and remission status were collected from the treatment records of the patients and analyzed using SPSS Version 23.0. A p-value of < 0.05 was considered significant.

Results: Thirty cases of ALL were diagnosed over the study period. The median age was 15years (IQR:6.6, 20.0). The most common clinical presentation was lymphadenopathy (73.3%), fever (63.3%), and mucocutaneous bleeds (33.3%). All the patients presented with anaemia [packed cell volume (mean±SD) 23.3± 8.2%)], thrombocytopenia [median (IQR)40.0 (15.0,130.0)] and leukocytosis [17.0(4.9, 80.0) c/mm³]. Induction chemotherapy used were cyclophosphamide, vincristine, cytosine arabinoside and prednisolone (COAP) (83.3%) and Vincristine and prednisolone (V+ P) (16.7%) with a mean of 4 cycles of administration. The remission rate was low (26.7%).  Neutrophil and lymphocyte counts at presentation were the only factors associated with remission (p=0.016 and 0.010 respectively).  Male gender, higher neutrophil count, lower lymphocyte count and V + P chemotherapy though positively predicted remission, did not reach statistical significance(p>0.05).

Conclusion: Remission status in ALL patients is still abysmally poor in our setting and neutropenia is an important independent negative predictor.